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TT with HD: The Andersons (Frank, Elaine, Sophie, Jasper and Eric)

[Ed. note: It emerges during the conversation below that Frank Anderson, MD, MPH is
a member of the Ob/Gyn Department's research faculty at the University of Michigan. A conversational thread
that comes later in the Talk
below centers around Dr. Anderson's public health projects in Ghana and Haiti.

The earlier part of the conversation stems from a way-larger-than-average pumpkin that the Andersons grew on their lawn
extension this year, which marked the third year in succession they have tended their streetside pumpkin patch.]

HD: What I'd like to do is, I'd like see if I can get all of you on the teeter totter on that side, and I'll take a quick portrait down the teeter totter.

FA: Come here, let's all sit on this side.

EA: Sophie!

FA: Sophie, come over here!

HD: Do you want to be in the picture? I'd love for you to be in the picture!

FA: Me, too!

HD: But you don't have to. I wouldn't force you to. You can bring your book, though.

HD: [to EA] Wow, you're standing up now, that's dangerous! So, you know, I did some background reading on hedgehogs, and it seems to me that the main concern is that they don't get enough exercise. Because, when they're out in the wild, they like to roam around the hedges, and they can do like maybe five or six miles a day? So, I was wondering, do you have a wheel for him?

HD: So, what kind of wheel is it, like one of those standard hamster wheels, or?

SA: It's bigger.

JA: It's about like that, about this wide. [indicates size with hands]

HD: Like a foot wide?!

EA: Like that. [indicates size with hands]

SA: It's not that much bigger, it's about that big, all the way around. [indicates size with hands]

HD: And is it made especially for hedgehogs?

EA: Yeah. He's got a hedgehog cage.

SA: It's built into the cage.

HD: Okay, so it's just part of the furniture that's built in, okay.

EA: Yeah. And it has three floors. The bottom, another floor, and another floor.

HD: And how do you get from one floor to the next? Is there a little elevator in there?

EA: No, there's ladders.

HD: There's ladders? Huh.

JA: Ramps.

EA: Ladder-ramps

JA: Ramps with bumps.

HD: Ramps with bumps so that he doesn't lose his traction? Okay.

EA: Why are those shoes up there?

HD: Oh, those are my old boots! From my Boy Scout days. I knew it was time to throw them away, but I wanted to keep them around, but throw them away at the same time. So I figured I'd throw them up in the tree, and they would be there for me to look at, but they would not be in my way anymore. So, is the pumpkin still on the porch?

HD: Now, Frank, you are doing a tremendous amount of work, I know. [Ed. note: With two boys now on his end, Frank's end is significantly heavier; whoever is on the heavier end has to exert more upward force to maintain tottering motion.]

HD: From my own experience, I know that you're getting a real workout.

FA: Should we move up a little bit?

HD: Well, I was thinking, if I could have one of the little ones back down on my end to help balance you out. Hey, Eric, you want to come over here? [to Elaine] We were just getting to the part about the pumpkin.

HD: So, is the compost pile something that you will actually pull compost out of and use for next year?

FA: Oh, yeah, sure. It's not as much a pile as it is one of those plastic containers.

EA: And it goes around!

HD: So, it's one of those drums that you rotate?

FA: That's right. We had three other pumpkins that we carved, so I put them all in there yesterday.

HD: Okay. So, this year it actually made it through the growing season, and through Halloween, without getting smashed!

FA: That's right! I'm the one who smashed them this year! It's really rare.

HD: So is that something that you actually get some good cathartic satisfaction out of, or?

FA: Yeah, a little bit. I kind of enjoy that. I tore them up--I broke all four pumpkins apart yesterday, and I did get a little satisfaction out of that.

HD: So did you stand on one side of the yard and like heave them into the--I mean with the container, you could make kind of a basketball game out of it, right?

FA: Well, actually what I did, I took a knife, I started cutting, I just tore them up. Just tore the pumpkins up. I was planting other plants, and I just put the pieces into the pot, and dumped them into the compost.

HD: Okay. So, how long does it take for the pumpkin to disappear and not be recognizable as a pumpkin anymore?

FA: I don't know. I saw one once--one year we had our pumpkins stolen. I think that was last year. Was it last year, Elaine?

Elaine: Yeah, last year it was stolen.

HD: So, last year it just disappeared, and you found no evidence of it?

Elaine: Well, we actually heard it.

FA: Elaine said she woke up at 12:30 at night, and she could hear a car stop, and a snap, and then a car take off again.

HD: Oh, man!

Elaine: [laugh] I don't know if it was in my dreams, but I don't think it was.

HD: Okay.

FA: But see, after that happened this huge pumpkin showed up on our front porch. Actually, not on our porch, but below our porch. It took two of us to carry it. It was just like somebody just dropped off a pumpkin in our front yard.

JA: Like that tall. [indicates size with hands]

HD: So, do you think it was the people who stole it, who sort of felt remorse? Or do you think it was maybe a neighbor who felt bad for you?

FA: Well, it was probably a neighbor who felt bad for us. It was a neighbor--we eventually found out who it was. Even before that, someone else had brought four or five smaller pumpkins and put them in the pumpkin patch as well when our pumpkins got stolen. So we've had a lot of pumpkins show up on our property over the years, because of this pumpkin patch. But this last big huge one, I took over to someone else's compost pile, and over the winter we watched it totally just deflate and then turn into nothing. It took about four months or so. It was really cool as it started to just deflate ...

HD: ... that would have been an interesting time-lapse photograph.

FA: Yeah, it would have been.

HD: So, how many years have you been growing a big pumpkin out there?

FA: It's the third year.

HD: So, the first year, it got smashed, and last year it got stolen, and this year, you made it all the way? Is that right?

HD: There's I guy I follow online, he carved a pumpkin, it was one big pumpkin in the shape of Pac-Man, so from the side it had the big gaping--you remember Pac-Man, right?

FA: Yeah, yeah, yeah!

HD: And then he had three smaller gords out in front of it, so it was like a Pac-Man pumpkin scene. But soon after he carved it, he reported that somebody had stolen the three smaller towards and smashed Pac-Man.

FA: Aw!

HD: I don't know what it is about human nature that wants to destroy that which others create.

FA: Well, the first year we had them, there were two big ones, and they got smashed on the night of a football game. And I figured that was people driving around at night--too tempting! Well, then next year at night, it was probably again about 12:30 or one o'clock at night and I heard some people outside in the front yard, and I looked out the window and there was someone who like had their arms around the pumpkin. So, my heart was beating fast, and I thought, They're going to take this home! And I said, Hey! I kinda yelled at them out the window, I said, Hey, stay away from the pumpkin! And they were like, Oh, well, we'd didn't mean anything by it! I'm like ...

HD: ... [laugh] ...

FA: I said, Well, last year they got smashed! They said, Well, that's not our intention! And I was still kind of riled up, probably slammed the window. Elaine was saying, Wow, you were really mean to them! And I felt bad about it, because I didn't really know what they were doing. They weren't going to steal the pumpkin. Then, about two weeks later, this guy comes by the house, with this thing of chocolate chip cookies. And he introduced himself--his name was Forest--and he said, Remember a few weeks ago, when you yelled at people outside messing with the pumpkin? He said, Well, that was me and my friends, and I just wanted to come talk to you about that.

HD: Oh, wow! So, he brought you chocolate chip cookies?!

FA: He brought me chocolate chip cookies!

Elaine: He made chocolate chip cookies!

FA: Homemade chocolate chip cookies. And he came in, and we had a great talk.

HD: You said his name was Forest?

FA: Yeah. You know him?

HD: No, I don't know anybody named Forest, I just didn't hear.

FA: Yeah, his name was Forest. He's an art student, a graduate art student at Michigan.

EA: He made a banana pumpkin, a carving of a pumpkin with ...

JA: ... a banana plant.

FA: And that will make sense in a minute. So, we talked, and he gave me the cookies. I don't know if you saw the banana plants I have in our yard?

FA: Yeah, they're dwarf banana plants. I got one a few years ago, and as they grow they send up shoots, you know so we've been able ...

HD: ... do they yield bananas?!

FA: No.

HD: Because they're dwarfs, I guess, huh? Hey, Eric, you want to scoot back, we get more leverage that way.

FA: So I had an extra banana plant at that time so I gave him one of the banana plants, and he took that with him. So when Halloween came last year, he came back to our house, he brought a pumpkin that he had carved with intricate carvings--it had our house, and our fence, and our yard, and it had the pumpkin in the corner, and it had the window on the second floor with a voice bubble that said, Hey, stay away from the pumpkin!

HD: That's amazing. So he had carved it to into the surface of the pumpkin? So, is that his field--you said he was a grad school art student?

FA: That's right. He was living across from Jefferson Market, and he was really interested in the whole neighborhood, and community, how that worked--kind of how people live who are not college students, I guess.

HD: So, in a way, it's a good thing that you did kind of bark at him.

FA: It was.

HD: Because, otherwise he might have said, Okay, those are pumpkin people. And then gone off and written something about it, or created a piece of art about it, but not necessarily have had an interaction with you.

FA: So, this year he came back with a pumpkin with a banana plant carved into it--that's what Eric was just talking about--because of that banana plant we gave him two years ago.

HD: Man. That's quite a story. So I assume at this point that people are counting on you to grow a big pumpkin next year, too, right?

HD: Yeah, I did actually take a trip over there, I'm trying to think, it would have been Thursday or Friday, I rode my bike past there to get a picture of it carved.

FA: Oh, good!

HD: The way the sunlight was filtering through, I'm not sure if the picture will be clear, but. So, when I was over there riding my bike through your part of the Old West Side, I noticed that there was a woman flyering along your street putting flyers on all the doors. I mean, I didn't stop and ask her what she was doing, but I'm wondering, did you get a flyer in your door about something?

FA: What day?

HD: Would have been Thursday or Friday, I guess. Friday, I'm thinking, actually. Because I was just trying to guess what it might have been--I should have just asked her. The election is coming up Tuesday, it's kind of a non-contested election, so probably not that. I dunno, do you follow city politics at all?

FA: I don't.

HD: Okay. There's only one person on the ballot, I think he must to live almost right around the corner from you, actually. Mike Anglin?

HD: So, what is your total animal inventory? You got the hedgehog. You've got a bunny ...?

EA: Two hamsters.

JA: Nine fish!

FA: Two hamsters, nine fish ...

SA: A cat!

JA: A cat!

SA: Snails!

HD: Snails??

FA: And a cockatiel.

HD: Do you count the fish individually, or do you say fish as one category?

FA: I would say fish as one category, but it looks like someone has been counting them, eh, Jasper?

EA: Nine sword tails.

FA: Nine sword tails. They were all babies. We had the parents, the parents had babies, two batches of babies, and the parents died for some reason. But all the babies have survived, and they have grown up to be adults.

JA: Not all of them.

FA: Well, not all of them, but a bunch of them.

HD: Now, did I hear you right, did you say sword fish?

FA: Sword tails.

HD: Oh, sword tails. I was thinking, well, I don't know that much about fish, but! Well, the other thing that was growing on your verge--is that what you call it, the 'verge', or the 'lawn extension'? What do you call that space between the sidewalk and the street?

FA: We call it 'the garden'. It's the only real sunny place in our yard.

HD: So was that in any way just an attempt to make it feel like back home in Memphis? You said you were from Memphis, right?

FA: That's right. [laugh]

HD: Now, is that just the last place you lived before coming to Ann Arbor, or did you actually grow up there?

FA: I grew up there.

HD: And how about you?

Elaine: I grew up in Massachusetts.

FA: Yeah, no, so I haven't lived there since '92. So, I moved out of there in '92. And then lived in Baltimore, and Arizona, and Washington D.C. ... [Ed. note: The microphone takes a tumble when Eric brushes past it. ] do you need to fix that?

HD: Maybe. Hey, Eric, can you hop off, and grab that microphone, and stand it up so that it is pointed towards your dad's end?

FA: But what gave me the idea of cotton is a neighbor up the street was growing cotton ...

HD: ... here in Ann Arbor??

FA: Yeah! You know, in his yard.

HD: So was it a little bit of one-upmanship, or? [laugh]

FA: He just gave me the seeds.

HD: Oh, okay.

FA: So last year, I planted them, but I didn't plant them soon enough--the cotton never quite matured. This year, actually, he brought me plants that he had started indoors.

HD: That's probably what you have to do around here, right? To get the length of the growing season?

FA: You do, yeah. I think cotton has a really long growing season and requires a lot of heat. At least it was hot in Memphis for a long time in the summer. Hot and humid. And so we've had a few of those bolls of cotton open this year.

HD: Wow. So, what are they called? The actual technical term for the thing that opens?

FA: Yeah. My mom was a big Elvis fan. One of Elvis's bodyguards was named Red West, and his son, Brent, and I were in the same car pool.

HD: Wow!

FA: [laugh] Yeah, we were in the same car pool in high school. So that's your four degrees of separation to Elvis.

HD: Right! So, I'm thinking of my own degrees of separation from Elvis, there's one to you, and from you to the bodyguard's son is one, yeah, from the son to the bodyguard, yeah, so I'm like a four? Not bad.

FA: Yeah. Brent hung out with Elvis.

HD: So the body guard's son would directly hang out with Elvis?

FA: Sure, yeah. He knew Elvis. [Ed. note: There's enough information here for readers to do their own degrees-of-separation arithmetic. HD comes out as 3 or 4 degrees removed from Elvis, depending on how you count and where the scale begins.]

HD: Wow. So, have you been back to--what is the name of his house?

FA: Graceland?

HD: Yeah, Graceland. I can't believe I couldn't remember the name. [laugh] Have you been to see Graceland after he died?

FA: Well, sure. Actually when he died, because my Mom was a big fan, she took us the next night, and we went over to the original candle-light vigil out in the parking lot across from his house. Because she just wanted to be there when he died. I guess I was in high school, it was in August, I was at home and she was at work, and when I heard the news on the television I called her up and told her, and she was really upset. I don't know if it was that night, or the night after that we went out there and just hung out in front of his house. And then afterwards it was a thing to bring visitors to. When people came to Memphis we would go out there to Graceland and see it. When Sophie was baptized we took everyone out--we went to Memphis for that--we went to the baptism and then we went all the way out to Graceland.

HD: The post-baptism celebration was at Graceland! So was Sophie baptized in the church that you grew up in, is that why you went back to Memphis?

FA: That's right. Well, not the church I grew up in, but the church that I started going to as I got older. We had a priest there that we really liked, he was a friend of ours. We were actually living in Arizona have the time. I was working for the Indian Health Service on the Navajo Indian reservation. And we went back for that. That was kind of a temporary place where we were living. He was the same priest that married us.

HD: So, you guys have really easy access to a great park, right? So on a day like today-- Sunday afternoon fall day--if you weren't over here teeter tottering, would you be over there in that park? Or what would at typical Sunday afternoon be like?

FA: Oh, let's see, a typical day for us?

HD: Yeah, a typical Sunday afternoon.

FA: Well, we do have great park, Wurster Park. And the kids have friends that live right behind the park as well, so that would be one place where we could be. We love to go to Kensington Park, too, and we love to bike there.

FA: ... oh, no, we would take our bikes there, and bike around Kensington. And then we've tried Island Lake Park once, which is right next to Kensington and kind of did mountain bikes through there. And that was a lot of fun. What else did we do, Elaine? You know, one place that we love is the Wave Field. Have never been to the Wave Field?

HD: This is on North campus?

FA: Uh huh.

HD: Sort of a sculpture, designed by the same woman who designed the Vietnam Veterans Memorial?

FA: That's right.

HD: That's sort of my standard description of it, I know to say that, but I've never been.

FA: Ohhhh, that's a great place to go!

HD: So you can go and sort of just lay down between the waves? I've seen photographs of it, so I can only imagine.

FA: You can jump from one to another, you can throw a kid from one to another, you can play hide and seek in the waves, and kick a soccer ball across the wave peaks.

HD: So, it's totally allowed to use it in the same way you would use an athletic field--it's just that there's waves?

FA: Yeah, yeah. Yeah, it's great fun. What else could we do on a Sunday afternoon?

Elaine: We love to walk downtown. That's more Saturday market ...

HD: ... to the Farmers Market? That's what, at 20 minute walk maybe?

FA: A good weekend for us would be when we don't take have a car anywhere, and just stay in the neighborhood, play in our yard. We kind of have a small yard, but our neighbors two doors down, they have a big backyard and they have made that available to us anytime we want to use it. So sometimes we go there and play baseball.

HD: When you think about your life here in Ann Arbor, have you gotten to a point where you think, Yeah, we're basically committed to Ann Arbor for the long haul! Or are you basically thinking of some other place geographically, maybe going back to a warmer climate, or--she's from Massachusetts--it's a lot different from Massachusetts here.

FA: We actually met in Baltimore. So we considered that home for a really long time. After Baltimore we lived in Arizona, and then Washington D.C. ...

EA: ... can I get off?

FA: Oh, sure! Yeah, so we didn't actually think we would be living in one place for a really long time like we have in Ann Arbor. We moved here in 1999, and we're really happy here, and so we don't really have any plans to leave. The kids are in school, you know ... [to Elaine] you going to go?

HD: Very nice to meet you!

FA: Okay, see you later, guys! Yeah, we're kind of surprised that we're still here. We've never lived in a place long enough to kind of establish community, because we moved around so much before we came here. So we don't have any plans now to leave. And I'm not sure we will be here forever, but I think at least until the kids get through high school. And then I think we'll have to decide what to do after that.

HD: Well, do you have anything else on your mind that you wanted to make sure we talked about on the teeter totter?

FA: [laugh] Oh, let's see here. Oh yeah, what do you do, Dave?

HD: Right now, I'm pretty much spending most of my time riding the teeter totter! So, I don't have a lot of structured demands on my time beyond this project. Maintaining the house--which is proving to be a lot more time-consuming then I figured it would be. These old houses are really nice, but they do require a lot of upkeep.

FA: And what did you get your degree in? I remember reading something about that.

HD: I went to graduate school for linguistics. I spent an awful long time in grad school for linguistics, and never actually completed the degree. Which is fine. But yeah, that's what my academic training is in.

FA: And what exactly is linguistics?

HD: The study of languages--what rules and patterns are discernible in not just individual languages, but what type of rules and patterns will you find in languages in general that you can explain and develop theories about.

FA: Where do those patterns come from? As in are they more innate, you know, and not cultural?

HD: Well, the sorts of patterns that I was working on were phonological patterns, sound patterns. So, what sorts of sound combinations are possible in a language, what kind of sound combinations are possible across different languages? As far as where do those patterns come from, the standard answer when I was back in school was something like, They are a function of the representations of those sounds that the human brain can construct. So there's a limitation on what a possible language pattern is, that is governed by the human brain. And to figure out what those limitations are is the goal of the scientific enterprise.

HD: ... yeah, Navajo is one of the parade examples for linguists of a bizarre language, of a really hard one ...

FA: ... yeah, the Navajo Code Talkers during World War II. Elaine and I took some Navajo language classes.

HD: Yeah, how did that go?

FA: It was tough. We didn't stick with it. We went to a few of the classes. I remember we were working on the vowel, A, and I remember maybe there were twenty different ways that an A could make a sound. It was one A, two A's three A's, and then one A with an accent. And then some of the clicks, and the sounds that you have to make, too

HD: Sounds that are totally outside of the phonetic inventory of English or of any of the Western languages that we are maybe vaguely familiar with.

FA: That's right. So we didn't stick with it. But it was really interesting. We had a lot of the Navajo nurses who would translate for the patients, because even what we would want to say to them didn't come across very well in English.

HD: So you guys are physicians?

FA: I am. Elaine is a physical therapist.

HD: So, I suppose that was a bit of a challenge. I mean, if you have a patient where you are trying to figure at what aches and pains will diagnose as what ...

FA: ... well, you know, the bigger challenge is trying to communicate to somebody issues around their health in, say, a compassionate way, as opposed like a threatening way ...

HD: ... or a clinical way ...

FA: ... or a clinical way. Because if I were to present some information to someone, even like a Pap smear--you know what a Pap smear is? It's a test for cervical cancer, it may be interpreted as, We think you have cancer, or ...

HD: ... yeah, why would you do a test, unless you thought there was a good chance that I have it?

FA: Yeah, that's right. Or, I'm a obstretician, so I deal with pregnancy. And there's a condition called gestational diabetes that people can develop, and it needs to be taken care of during pregnancy ...

HD: ... now, this is something that the mother has, or the fetus?

FA: That the mother has, right. And it can affect the fetus. But diabetes in an adult for an older person can be a really serious disease. There are a lot of complications--blindness, reduced vascularity in the limbs. And so it's always hard to communicate accurately to people, because they may hear 'diabetes' and think, Oh, I have this really severe disease that my grandfather had and had to have an amputation or something. So using English was hard. We really had to communicate through the nurses, so that people would understand clearly what they had, so we could take care of it. So, instead of saying, I'm going to do a Pap smear to see if you have cervical cancer, it's more like, Well, this is a test to see abnormal cells, to see if you have them--I think that's how it got translated. And then people, if they knew what kind of test they were having, and if there was abnormality, then they would feel comfortable about coming back. Instead of feeling like they didn't know what they had in the first place, and didn't really understand what the test was, and wouldn't come back for follow-up. So you know it was like it was a really ...

HD: ... yeah, I think it would be hard enough to achieve clear communication even when both patient and doctors speak English.

FA: Yeah, sure. Because you can talk to a patient and then they just hear certain points, you know.

HD: So then, most immediately prior to here, it was Memphis and then Baltimore then Arizona?

FA: That's right. Elaine and I met in Baltimore. We were both going to graduate school. She was in the Peace Corps and had been in Malawi for two years.

FA: Yes. As a physical therapist. And then she decided she wanted to get a degree in public health. And I had just finished my Ob/Gyn residency, and I wasn't really thinking I would go into private practice, either. I had been overseas a little bit on a couple of rotations, and so I had gotten interested in public health, too.

HD: So, as a part of your residency, they just rotated you overseas somewhere?

FA: No, no, I chose to do that. I just had an interest in doing that. I went to what was then Zaire, and spent one month there doing obstetrics and taking care of patients. But we had a lot of women who died during pregnancy during that rotation. And so I got really interested in prevention and how some things can be prevented. That's how I ended up in public health school.

HD: So, when people talk about infant mortality, does that statistic include cases where the mother actually dies before the baby is delivered?

FA: No. No, it doesn't.

HD: That's a different statistic?

FA: Infant mortality would be just for infants, usually one year or less. And there's under-five mortality, there's different ages. And then there's death within seven days of delivery, too, neonatal mortality. And then there's maternal mortality. It's true that when a woman dies, oftentimes her baby will die too, because of whatever complications, because what affects her can affect the baby. But sometimes these things happen after the baby is born. In the world there's about half a million women who die from pregnancy-related causes a year.

HD: Wow.

FA: That's like one a minute. And in the U.S., it's about one a day. Maternal mortality is the health indicator with the greatest disparity between developed and developing countries. In some countries, like Malawi being one, about 1 percent of women die from childbirth.

FA: Oh, it's measured per 100,000 live births. So, in the U.S., it's like ten per 100,000 live births, and in Haiti, where I have a project, it's like 800 per 100,000 live births. A huge disparity. Almost 1 percent.

HD: So, when you say you 'have a project' there, this is on-going right now?

FA: Mmm, hmm, yeah. I have a project in Ghana and a project in Haiti.

HD: Is it a research project, or is it a delivery of health services kind of project?

FA: It's kind of a combination of both. Only research in these settings doesn't quite make sense. It's like, What kind of research can you do to help provide services in that particular setting? There's a term for it called 'health research for development'. So what kind of development goals is a place trying to do? Maternal mortality reduction is one of the U.N. millennium development goals and its overall public health priority right now. In Haiti, we've been looking at rural communities, to see what kind of factors keep people from coming to the hospital.

HD: So the hospitals are located basically exclusively in whatever urban, more concentrated settings might exist.

FA: Right. So, what could we do at a community level to make a complication not get so severe that a person makes it to the hospital and then can't be treated.

HD: So you don't end up seeing at the hospital only those cases that are actually beyond being able to help them.

FA: That's right. Because when you have to travel so far, your condition can deteriorate as you make the trip. Especially if there's a delay in deciding to go to the hospital.

HD: Where they think, Oh, it's such an ordeal to make that trip, do I really want to waste a trip?

FA: It's an ordeal, it's expensive, maybe my husband doesn't want me to go, or my mother-in-law doesn't want me to go, or whatever the factors are that would delay someone from trying to make it. So that's what were doing in Haiti. And in Ghana--I'm at the University of Michigan--and our department has been working with two medical schools in Ghana for a really long time. It was involved in training medical students to become Ob/Gyn's. Before that, people would have to go to other countries to get that training--come here, or to Great Britain. And then they would stay--for good reasons. And so our department and some other medical school departments in the U.S. and also in Great Britain, teamed up help with the medical schools, to develop a training program that would happen in Ghana.

HD: So the Ob/Gyn training takes place in the country where the care is actually needed. Instead of taking the people, shipping them overseas, educating them, they discover that, Wow, life is actually much more pleasant over here ... and who could blame them?

FA: And who could blame them. Right, exactly. This program has now trained 40 people, and 39 have stayed in Ghana. So that's a big difference in. They call it 'brain drain', which is not the best term--it's retention, retaining people in the country. Because in Ghana, at least five years ago, 70 percent of their medical school graduates were leaving the country--because they didn't really see opportunities for training, pay, things like that. There's a lot of push factors out there. And this program was like a pull factor. And once people got trained, they could be economically successful, and then they also had this social connection that they were home, and that's what they wanted. So, we've been trying to look at that. I just wrote that paper that looked at those factors that were related to retention, and we're trying to do that to get some funders interested in replicating that in some other departments. It's human capacity development ...

HD: ... so, other departments within the medical school?

FA: In Ghana, yeah. Our medical school and the Ghana medical school. Actually it's starting up in pediatrics now. The business school at Michigan had a grant competition for medical school departments to see who wanted to replicate this program that was done through the OB department. And so, now, pediatrics is going to work on doing that.

HD: So OB and Pediatrics. After that, if you could wave a magic wand to add another apartment, in terms of what you see as the need, what would you add?

FA: Yes, but it has to be adapted. Malaria is a huge problem in Ghana. It's probably the disease that has the most burden for productivity and morbidity. Malaria is so prevalent there, so ...

HD: ... don't we--this is, I guess, just my ignorance--but I thought malaria was a disease that we had basically mastered? That we have drugs to take care of that?

FA: Yeah, no. Not at all. Not there. There are drugs that take care of it, but when health systems aren't in place to deliver those medicines, or people who can actually diagnose, and make sure those drugs are available. But no, malaria is still a huge problem. And it kills about four million people a year in the world.

HD: Okay. Because if you had asked me, What's the deal with malaria? just based on what I think I happen to know, I thought back when they built the Panama Canal, there were a lot of American workers who felt ill with malaria, and then wasn't it Walter Reed who focused on curing malaria? Anyway, in my head, I have a little historical anecdote that I can tell that has this very happy end: And that's how malaria was cured!

FA: [laugh] There's huge efforts to do something about malaria now world-wide. It's one of the top priorities for the World Health Organization and international health programs.

HD: Earlier you mentioned the U.N. in connection with your project in Haiti and just now the W.H.O. These projects that you're running, do they have support from international organizations like the U.N. and W.H.O.?

FA: No, not quite like that. I mentioned the U.N. only because the U.N. has this framework for development goals, goals for 2015 for the world. Alleviating poverty, or increasing child health, increasing maternal health, and things like that. The U.N. and the W.H.O., they kind of provide the framework for how to think about these things. No, there's not a lot of funding in this.

HD: So, there's not a lot of money flowing your direction?

FA: [laugh] No, there's not a lot of money flowing into these projects.

HD: This business-school-sponsored competition you mentioned for replicating the program, when I think of the Ross Business School, I think of big bags of money--that's probably not fair to them, but that's just my general impression. Are they pumping some cash into this?

FA: It's a 100-thousand-dollar grant. It's about opportunities for replication. They are just interested in jump-starting that process. There may be other funders, other foundations that are interested in this project. The Carnegie Foundation funded the original one that I was talking about for the OB Department. That ended up being like 10 million dollars that they put in over a ten-year period.

FA: Yeah, that's a chunk of money. We still bring residents over, we do have some exchanges with students and faculty and residents, but you know the Ministry of Health in Ghana runs it all now. It's all sustained by the universities there. So it's like this investment to create this capacity that hopefully will just continue on. We've maintained this partnership with them. [University of Michigan President] Mary Sue Coleman is going to go to Ghana in February.

HD: Really??

FA: Mmm hmm.

HD: To visit this project specifically?

FA: Well, to visit the university. This is one project, but the University [of Michigan] has lots of projects in Ghana, it turns out. Health projects, arts, maybe some archeology, things like that. Some faculty from the engineering school and I met earlier in this year. I just gave a talk on maternal mortality to a design class in the engineering school.

FA: Isn't that cool? Well, one of the faculty members got a grant to take some undergrads to Ghana this summer--it's also part of a program where we send students over to Ghana in the summer to do some health projects. So, these engineering students and the health students, will hopefully get together and look at maternal health and maternal mortality and maternal complications, and see, are there engineering solutions to this problem? Like transportation.

I was just at a conference, and I met a guy, an engineer, who developed this motorcycle with a side-car kind of ambulance. So it's like this motorcycle-ambulance. He said every health center in Malawi was going to purchase one of these, and keep it at the health center, so when they had a pregnant woman who needed to go to the hospital they wouldn't have to call the hospital, where there might be one ambulance, a four-wheel drive that costs fifty thousand dollars to stay at the hospital. Now they've got these motorcycle-ambulance things at the health center that they can take somebody to the hospital and bring them back. And they're like 6000 dollars each. So that's an engineering contribution to this health problem. And so they're going to hang out and assimilate, and digest ...

HD: ... and figure out what they might be able to design and engineer that might help the situation.

FA: Yeah. So, I gave them a lecture last week to a design class--I don't know if any of them will actually go to Ghana or not--and presented the problem to them. They have a Wiki-- you know, a Wiki?

HD: Oh, a Wiki? Yeah, yeah, yeah.

FA: I don't know too much about them, but they are composing a document through a group process.

HD: Yeah, yeah, that's the hallmark, I guess, of the whole Wiki concept is this open editing framework, collaborative endeavor. Hmm. That's fascinating stuff. So you're up to a little bit more than just growing pumpkins!

FA: Oh, yeah! Yeah, also, I teach Sunday school at the Buddhist Temple.

HD: Oh, yeah?

FA: At the Zen Buddhist Temple, yeah.

HD: I guess I'm surprised that there even is a Sunday school at the Zen Buddhist Temple!

FA: [laugh]

HD: I guess I always thought of that place has just a place where people go and meditate. Do your kids go to the Sunday School there?

FA: They do, they sure do. Yeah, we've been going there since since before Eric was born. And Eric, he's six years old. They have a lot for families there. You're right, it is a place where people go to meditate--it's got that wall and everything.

HD: Yeah, I've never been in there. I've been by it a thousand times, but never gone in.

FA: It's a Korean Zen tradition. It was started by a man who came from Korea. He has a temple in Toronto, here in Ann Arbor, Chicago, and Mexico City. Elaine and I learned about Bhuddhism when we were in Thailand. Between the time when we in Baltimore and Arizona, we took some time off and travelled in Asia, and we ended up at a Buddhist retreat center for foreigners in Thailand, and that's when we first learned about it. When we came to Ann Arbor--they have a lot of Buddhist things here in Ann Arbor. They have the Korean Zen Temple, they have Barbara Brodsky, who does kind of ...

HD: ... she was actually the most recent guest here on the teeter totter!

FA: Oh, well, anyway we started going to that temple. I always wanted place to bring my kids, you know? Because it wasn't about me going off to meditate someplace, and they had the kids program there. It wasn't really big, but they did have a kids program. Maybe once a month, we would go and bring the kids. Over the years there's been a different number of families that have wanted to participate. But the kicker was they bought that bike shop next to the temple. Did you ever see that, or were you aware of that?

HD: I know that they shuffled things around, right? The bike shop is still there along Packard ...

FA: ... it's on Packard, but they moved a bit--it's kind of north of the temple now, where it used to be right south. Where the bike shop was is now a part of the temple, a big open space. And we started doing the family programs in there and there's just been a lot of families there that keep coming.

HD: So how many kids are there? So like how many were there this morning, were you there this morning?

FA: Well, no, it's the second Sunday of the month ...

HD: ... oh, so it's not every Sunday.

FA: It actually just started every Sunday, but it's one Sunday a month there's the big Sunday School, where all the families come. I would say there's probably 30-40 children there. We have a teen group, and a middle school group, and a grade school group.

HD: And you handle the grade school group?

FA: Well, we have a service for parents and kids that lasts for about thirty minutes, and we do that first. And then they break off into small groups. And so I lead that big service and then I do the teen group.

HD: There's all kinds of stuff going on in this town that I had no idea about.

FA: A lot of people are there who are interested in some--maybe I shouldn't speak for everybody--but you know there's not a kind of dogmatic faith there. It's more like learning about mindfulness, and presence, although we try to teach the kids to meditate a little, too.